Disease Specifics for Hospice Admission

In order for a patient to be eligible for hospice care their primary doctor must certify that the person has an advanced disease or combination of diseases which will limit their life to 6 months or less, if the disease follows its natural course.

The Hospice Medical Director must also review and certify terminal status of the patient, based on Medicare standards, before they can be admitted to the program.

This process can be lengthy if the documentation in the medical record does not support the terminal status or if the primary doctor chooses a diagnosis that does not fall within Medicare guidelines for Hospice admission.

Below are Local Coverage Determinations (LCDs), hospice admission criteria followed by the Centers for Medicare & Medicaid Services, for common terminal diagnoses. In order for someone to be considered “hospice appropriate” their disease process must have medical documentation that meets the following criteria under their primary doctor’s chosen diagnosis for hospice admission.

Select the appropriate diagnosis below for more information about certification criteria:

*The determinants within these guides should not take the place of a physician’s clinical judgment.

CHF/Heart Disease
COPD/Pulmonary Disease
CVA /Stroke/Coma
Huntington’s Disease
Liver Disease
Neurological Diseases 
      ALS (Amyotrophic Lateral Sclerosis)
      Muscular Dystrophy
      Myasthenia Gravis
      MS (Multiple Sclerosis)
Renal Failure, Chronic or Acute

Palliative Performance Scale (PPS)
New York Heart Association (NYHA) Functional Classes
Functional Assessment Staging (FAST) Scale

Frequent Co-Morbidity documentation requirements
Cachexia or Protein Calorie Malnutrition

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